Medical Emergencies Flashcards
What details should be recorded on someone’s faint/collapse episode?
- ) Circumstances of event
- ) Posture just before loss of consciousness
- ) Prodromal symptoms (sweat/warmth)
- ) Presence or absence of movement during event
- ) Tongue biting?
- ) If injury occurred during event
- ) Duration
- ) Copies of the ECG and patient report form given on transfer of pt.
What 3 things can cause faints/collapse
- ) NEUROGENIC SYNCOPE
- ) CARDIOGENIC SYNCOPE
- ) NEUROCARDIOGENIC SYNCOPE ‘SIMPLE FAINT’
SYNCOPE = FALL IN BLOOD PRESSURE
What are the features of a Neurogenic Syncope (brain)
- Also known as a vasovagal syncope - natural mechanism of falling so blood goes back to the brain
- Occurs when body overreacts to triggers like intense emotion/sight of blood/heat/dehydration
- History of neurogenic problems: Epilepsy
- Loss of sphincter tone (urination)
- Tongue biting
- Prodrome (pre-expectancy)
- Clinical features
What is the difference between a faint and a collapse
Collapse - sudden loss of postural tone
Faint - transient loss of consciousness
What may be the cause of Neurogenic syncope
- Seizure / Epilepsy
- Sub-arachnoid haemorrhage
- Not stroke
What is a Cariogenic syncope (heart) and what may cause it
• Arrhythmias:
- Bradycardia
- Tachycardia
• Valvular pathology:
- Aortic stenosis
- Mitral stenosis
- Structural heart disease: Hypertrophic Cardiomyopathy (HCM)
- Pulmonary embolus
- Primary Electrophysiological Abnormalities
- Brugada syndrome
- Long QT syndrome
How diagnose a syncope as a Vasovagal one (Neurocardiogenic)
- Commonest type of faint
- 3 P’s - Posture, Provoking, Prodrome
- Transient LOC
- Rapid recovery, often ongoing headache, mild nausea
- Overstimulation of vagus nerve +/- sympathetic tone loss
Name the NICE Red Flag Signs with a syncope (leading to the belief that it is not vasovagal)
Refer within 24 hours for specialist IF:
- ECG abnormality
- Heart failure (history or clinical signs)
- TLoC during exertion
- Family history of sudden cardiac death in people aged 40 years
- Heart murmur
How do we treat faints
• Assess the Airway, Breathing, Circulation (ABC)
- Lay flat, elevate legs, recovery position if necessary
• If occurs after unpleasant stimulus (LA injection) and recovery rapid
What is Hypoglycaemia
- Lower than normal blood sugar
* Normal ranges 4 - 7
What are the features of Hypoglycaemia
- Hunger
- Irritability
- Headache
- Altered/reduced LOC
- Difficulty speaking
- Ataxia dyscoordination (drunkenness)
- Seizures
What are the causes of Hypoglycaemia
- Too little fuel
- Too much insulin
- Excess oral diabetic drugs
- Alcohol induced hypoglycaemia
- Sepsis
- Insulin-secreting pancreatic tumour
- Adrenal insufficiency / Hypopituitarism
How do we treat Hypoglycaemia
- SUGAR
- Carbohydrate if symptoms minimal (Jelly babies)
- Increasing symptoms use oral gel
- IV if significant symptoms (seizures - can’t swallow)
- Hospital assessment focused on treatment and identifying cause
What is Anaphylaxis
- Extreme allergy
- IgE mediated (anaphylactoid reactions clinically similar but not IgE mediated)
- Caused by reaction to allergen (food / drugs / NSAIDs)
Describe the pathophysiology of Anaphylaxis
- Antigen binds to IgE antibodies on mast cells based in connective tissue throughout the body
- Degranulation of mast cells with release of inflammatory mediators
- Inflammatory mediators cause common symptoms of allergic reactions, such as itching rash and swelling
- Can also cause bronchial constriction, vasodilation
- Anaphylactic shock is an allergic reaction with respiratory symptoms and circulatory collapse - can be fatal if untreated in time
What are the clinical features of Anaphylaxis
•Respiratory distress:
- Stridor
- Tachypnoea
- Wheeze
- Cyanosis
• Circulatory signs:
- Pallor
- Cool peripheries
- Tachycardia
- Hypotension
• CNS:
- Anxiety
- Agitation
- Reduced LOC
GI:
- Abdominal pain
- D&V
SKIN:
- Urticaria
What does the Resuscitation guidelines say for an anaphylactic shock
1.) ABC
- ) - Call for help
- Lie pt. flat
- Raise pt. legs
3.) GIVE ADRENALINE 500mg
4.)
• Establish airway
- High flow oxygen
- Chlorphenamine
- Hydrocortisone
- Nebulised B agonist (salbutamol)
What is the treatment course if this happened in your practice
- Remove/Stop cause
- Assess A B C
- Intramuscular adrenaline 500mg
- Oxygen
- Nebulised B agonist (salbutamol)
- 999 to ED
What is Asthma
- Increased airway activity
- Atopic/non-atopic
- Various triggers
- Acute attacks - wheezing, SOB, ‘tight chest’, cough
How do we treat an Asthma Attack
- Try and prevent allergen
- Inhaled B-agonists - salbutamol, terbutaline (ventolin)
- Steroids if indicated to reduce airway inflammation - does not cause immediate relief in asthma attack
- Others - Magnesium, IV aminophylline, venitlation
How does Ischamemic Heart disease happen? What is the process?
- Coronary arteries around heart supplies it with O2 etc..
- High cholesterol and high blood pressure with turbulence can erode some of the lining of the blood vessel away.
- This exposes the tissue underneath and so a fatty streak is formed to reduce the blood flow around it. This narrows the vessel.
- This narrowing causes the protective layer to become necrotic plaque
- This plaque can rupture with flow of blood and exposes the vessel underneath leading to a clot - blockage of arteries - chest pain symptoms etc..
What are the 3 types of Ischaemic Heart Disease
• STABLE ANGINA:
- Pain on exercie, relieved by rest +/- GTN
• UNSTABLE ANGINA:
- Worsening pain esp at rest, increasing frequency of episodes
• MYOCARDIAL INFARCTION:
- Syptoms, ECG changes, biochemical markers (troponin) 10/10 pain.
What are the symptoms of someone with Angina / MI
- Chest pain +/- radiation
- Nausea/Vomiting
- Collapse
- Sweating
- Pallor
- Anxiety
How do we treat Angina/MI
- ABCDE
- GTN spray (nitrates)
- Aspirin (300mg) chew
- Oxygen (if indicated <94% SpO2)
- 999 to ED
•Primary PCI for AMI that meet criteria
STEMI more serious needs immediate treatment
• MONA:
- M = Morphine
- O = Oxygen
- N = Nitrates
- A = Aspirin
What is Adrenal Insufficiency
- Inadequate production of steroid hormones
- Primarily cortisol
- May have impaired aldosterone production
- Several causes
Causes of Primary Adrenal Insufficiency (impairment of adrenal glands)
- Idiopathic
- Autoimmune - ADDISON’S DISEASE
- Congenital adrenal hyperplasia
- Adenoma (tumour) of the adrenal gland
Causes of Secondary Adrenal Insufficiency (impairment of the pituitary gland or hypothalamus)
- Pituitary microadenoma
- Hypothalamic tumour
- Sheehan’s syndrome (postpartum pituitary necrosis)
What are the causes of Adrenal Insufficiency?
- Weakness, tiredness, dizziness, hypotension
- Hypoglycemia, dehydration, weight loss, disorientation
- Myalgia, nausea, vomiting, diarrhoea
- Hyperkalemia & Hyponatraemia
- Palmar crease tanning
- Vitiligo
Clinical features of an Adrenal Crisis
- Lethargy, fever
- Abdominal pain
- Severe D&V (+/- dehydration)
- Hypotension
- Hypoglycaemia
- Syncope
- Confusion, psychosis, slurred speech
How do we treat Adrenal crisis
Give steroid before treatment if you know they have addison’s/pituitary disease
If crisis - 999 if ABCDE fine
What is a Seizure
- Not always epileptic
- Several types
- Difficult to diagnose
- Classic seizure dramatic, but rarely problematic
Difference between a Partial and a Generalised Seizure
Partial - one part of his body - may have LOC (simple / complex)
Generalised - all have LOC (absence, tonic-clonic, myoclonic, tonic, atonic)
What are the causes of a Seizure?
- Epilepsy (including drug non-compliance or interactions)
- Fatigue
- Intracranial lesion
- Drug and alcohol intoxication/ withdrawal
- Intracranial infection - encephalitis or meningitis
- Metabolic disturbances - hypoglycaemia, hyponatraemia or hypoxia
- Multiple sclerosis
How to manage a Seizure
- Protect patient from injury
- Most come to no harm at all, post-ictal phase may be distressing and prolonged
- Classic tonic-clonic seizure rarely more than 1-2 mins
- If prolonged - assess ABC and call 999
